01 October 2008

I know this will piss off many of my fellow travelers, but I wanted to come out and say it for the record. Don't worry, I am not about to turn in my credentials as a card-carrying member of the Angry Left. My objection may be more semantic than anything else, but words mean things and it is important to be clear in important in matters like these.

Fellow bleeding heart (and shyster) JimII said it well in the comments the other day: rights are limitations on government power. Exactly. When we use the language of "rights," we are generally discussing very fundamental liberties, which are conferred on us at birth, and which no government is permitted to take away: free speech; religion and conscience; property; assembly and petition; bodily self-determination; self-defense, and the like. Freedoms. Nowhere in that list is there anything which must be given to you by others. These are freedoms which are yours, not obligations which you are due from somebody else. There is no right to an education, nor to a comfortable retirement, nor to otherwise profit by the sweat of someone else's labor.

Now some societies, ours included, from time to time decide that its citizens, or certain groups of them, should be entitled to certain benefits. Sometimes this justified by the common good -- a well-educated populace serves society well, so we guarantee an education to all children. Sometimes this is derived from humanitarian principles -- children should not go hungry, so we create childhood nutrition programs. Healthcare would, in my estimation, fall into the category of an entitlement rather than a right.

Some who claim that healthcare is a right have held out the UN Declaration on Human Rights as a standard, but my reading of the document is that it is admirable but hopelessly muddled on this distinction. I think it's important to be clear on the difference between a right and an entitlement. Rights tend to be more fundamental, more important, and deserving of higher levels of protection and scrutiny. Entitlements shift as social conditions change, as values evolve and as economies grow and shrink. They may be given only to certain defined groups, but rights are universal in their nature, and rights are very infrequently modified. Entitlements differ from place to place and time to time. Entitlements may, albeit rarely, be rescinded or reduced. And they are in most cases paid for by individuals who are not the beneficiaries.

Our nation has long defined health care as an entitlement for the eldery, the disabled, and the very young. We are now involved in a national debate whether this entitlement will be made universal. As you all know, I am an advocate for universal health care. Though there may be an argument for the societal benefit of universal healthcare, or for the relative cost-efficiency of universal healthcare, I support it almost entirely for humanitarian reasons. It needs to be paid for, of course, and that will be a challenge, but as a social priority it ranks as absolutely critical in my estimation. If I, in the future, make the mental error of referring to healthcare as a right, understand that I mean that it is an entitlement, and an important one. (And remind me to be more careful with my verbiage.)

There is a common line of argument against universal healthcare, derived from the (hopelessly muddled) objectivist school of thought. It has been most commonly expressed (or approvingly linked to) as:

[W]ith any good or service that is provided by some specific group of men, if you try to make its possession by all a right, you thereby enslave the providers of the service, wreck the service, and end up depriving the very consumers you are supposed to be helping. To call "medical care" a right will merely enslave the doctors and thus destroy the quality of medical care in this country [...] It will deliver doctors bound hands and feet to the mercies of the bureaucracy.

There's a lot not to like about this sentiment, but some limited validity. The argument is somewhat fatuous in that it rails against a hypothetical socialist system which does not actually exist, in which providers are not paid for their services. On the other hand the argument ignores the fact that such a system already exists, and in some respects might be mitigated by universal health care.

For example, as our Dear Leader said, "[P]eople have access to health care in America. After all, you just go to an emergency room," and he was right. You come to see me, and I will take care for you, and any specialist you need will come in to provide whatever service you need. Sure, this isn't any sort of comprehensive health care, and certainly isn't the best way to get health care. But it's there. Only problem is, I and my colleagues are not caring for you out of the goodness of our heart, nor out of charity, but because we are obligated under federal law to do so. While this isn't exactly slavery, this coercion of our work product is essentially compulsory if you work in a US hospital.

Universal health care, or, more precisely, universal health insurance, might improve upon the current state of affairs by ensuring that doctors are always paid for the services we provide, rather than being obligated to give them away to 15-30% of their patients as we now are.

The typical emergency physician provides about $180,000 of free services annually, just for reference.

As for those who claim that the slavery of universal healthcare is rather in the loss of physician autonomy, or in the corruption of the free market, I have one thing to say to them: that ship has sailed. Medical practice is irrevocably governed by a Byzantine maze of laws, regulations and standards set by a veritable alphabet soup of commissions and independent organizations. That is not going to change for the large proportion of physicians who have the need to care for patients in or incident to the hospital setting. Furthermore, there is no free market for physician services as it mow exists. Prices are set by the federal government for about half of Americans, and by a cabal of large insurers for the rest. Doctors can negotiate their prices within a narrow range with individual insurers, but the success of this is determined by the regional strength of each payer, not by the quality of care provided by the doctor, and while you can set the conversion factor for your fee schedule, you cannot set the price for each individual service you provide.

While there is a growing trend towards boutique medical practices and freestanding ERs, these are and will remain small niche players for those patients able to afford them. For the vast majority of physicians, we are stuck with the current system. Universal health care is unlikely to fundamentally change the status quo for physicians in this regard.

Bottom line: No, Health Care is not a right. When advocates of universal health care misuse the language of universal rights to push for health care for all, we fall into the trap of over-reaching and provoke a justified pushback, even from some who might be inclined to agree with us. Universal health care is, however, a moral obligation for an industrialized society, and will not result in the apocalyptic consequences promised by the jeremiads.

51 comments:

Whatever word describes how government takes our money and spends it I think should influence the word that is used for what it is spent on.

Since how much is taken, why it is taken, and what it is spent on varies so much, I think there can be a little variety in describing our "rights" to determine what it is spent on.

If they spend $1 to deliver 50 cents in benefit, I think we have a "right" to say: stop the waste of that 50 cents.

Government does spend a lot of money on problems caused by people who get insufficient health care, on inefficient health care, and on effects on the economy that can be partially attribute to insufficient and inefficient healthcare.

However, these are difficult to quantify. I think a "right" could be to say: stop taking these monies from us, or spend it on making health care more efficient.

You've written a very thoughtful and articulate essay, and made some valid points about the issue of entitlements vs. rights.

I disagree, however, with your assertion that: "Entitlements may, albeit rarely, be rescinded or reduced."

The mental health community has been virtually eviscerated by funding cuts, to the point that patients without private insurance often wait 3-4 months for an intake appointment with a CMHC social worker, 6-8 months for assignment to a case manager, and 3-5 months for an evaluation by a psychiatrist (these numbers may vary by community and state).

There are fewer beds per 100,000 population than ever before, and this shortage affects the privately insured as much as those on Medicaid, Medicare, or without insurance. Suicidal patients are often boarded in ED departments or on medical floors without appropriate treatment for up to a week.

This year, the Governor of Ohio (a Democrat!) closed two State Psychiatric hospitals in order to balance the budget. Our city has lost one of its three large, free medical clinics to budgetary shortfall, as well.

Nationally, we've gone from approximately 6,000 operating EDs to somewhere around 3,800 in the past decade. I imagine the losses were frequently due to financial problems.

Entitlement programs are often included in the first round of state and federal budget cuts, and it seems there are many taxpayers who don't want to fund it at all.

You're only "entitled" to what you earn fairly, IMHO. Everything else falls more into the category of charity and/or forced redistribution of wealth. In other words, entitlement is a bit of a misnomer.

Also, you should understand that by declaring health care an "entitlement", I and other privately insured people will have less access to quality health care than before in all likelihood (eg. in England where specialists, imaging, surgeries, cancer treatment are limited relative to the US). Therefore, an entitlement for all means less for most. To take your argument to its logical conclusion, I am entitled to less than I'm currently getting.

Universal health care would be nothing more than a redistribution of wealth--those who are doing just fine in the current system giving up money and quality/quantity (ie what they're entitled to because they earned it fairly) so others can supposedly get health care that they're not currently entitled to for whatever reason.

For once I found myself in mostly agreement with SF on a somwhat political post. What nursK says is also true. Universal care bust be rationed and limited to get the most bang for the buck, but there also needs to be a higher tier that I can pay for myself. The governemt could afford to give everyone a healthcare Yugo to drive, but if you want the Lexus, earn it, and pay for it yourself

spending billions on brain dead alzheimers patients in the ICU, heart transplants for your crack induce cardiomyopathy and other nonsense is not going to fit into that Yugo of healthcare

First of all, I would like to thank the cosmos that I have found a liberal Doc blog. For the past year of medical school I have been floating around the blogosphere reading horrifically conservation med blogs. I will not name names but I believe that although so many Docs are annoyed by the system, at the end of the day they go home to a comfortable living situation, add to their savings, and enjoy the lifestyle of the top .5% of the world.

I have seen too many people write off Universal Healthcare and chose to vote conservative just because they don't want to shell out taxes and are afraid a big change will rock the boat. Their boat. Case in point: Nurse K's comment. She does not want to lose what she currently has. She is fairly set. She works hard and does not want any compromises in how she lives. This is a moral standing point that she is not likely to change although it is one, that in my opinion, is constructed on FEAR and insecurity.(As a sidenote, I am suprised that a nurse would have such confidence in a private health insurance company. Has she not gotten sick yet and have them deny her claims with every slick trick in the book? Good for her.)

Well, this debate comes down to a moral standing point. Am I willing to risk my lifestyle and make sacrifices in the hope that more can enjoy basic human rights and humanistic benefits like healthcare, disability, and other social gifts? I am. It is called social progress and it is what has gotten us from roaming, feuding tribes of primitive men and women to the societies that exist today. If conservatives were left unchecked we would most certainly still have slaves, a domineering church, and not be making strides in the rights of gays/lesbians. While every group, including liberals, need their checks and balances, I believe social conservatives such as McCain and Palin constantly just keep us 50-100 years behind in social progress.

I think there is a lot of complacency and apathy that goes on within conservative thinking. It is short sited. What goes around comes around and when the top tier gets too high above the populaces, it will equalize eventually. Why not begin with a new wave of social projects that does not leave the historical marginalized and the unfortunate in the cold?

We have an inefficient, unequal, shitty health care system that needs an overhaul. Insurance companies rape and pillage. Docs give away services. Primary care nurses have to spend their days calling in preauth's for medications. Patients get treated by overwhelmed and overloaded docs. Nothing works here. What are we trying to preserve?

Why the f@ck are we all afraid to change?

Wall street just ran people into the ground. Their savings, their retirements, their homes... Why trust health care to the same people? Why corporate care and overpaid CEOs? The government may not be perfect but 1 system, social equality, and money spent on people instead of battling with health insurance companies sounds like a good plan from where I sit as a humanist, future doctor, and social liberal.

Please pardon the rant grammar, I need to skip the proofreading and get back to studying.

Love the car analogy. Rationing is an essential part of universal health care. One of the refreshing things I found when I moved to the socialist paradise of Sweden was that rationing is openly discussed here. This contrasts with Australia where people have a strange expectation of getting the best/fastest/latest etc via universial health care. One other thing that is slightly strange is that countries with universal health care spend much much less of GDP on health than country(s) that don´t have it. I thought this would appeal to those fiscal conservatives on the right of politics in the US or have they gone the way of all things...

You make some good points, but are too focused on primary rights. In particular, you've missed the fact that for sick people health care - or lack thereof - is a significant constraint on our civic, political, and (especially) economic participation, for reasons having nothing to do with the specifics of our illnesses and everything to do with the organization of society. Because we have a right to participate just as much as anyone else, the constraints imposed by health care amount to subtle but often severe discrimination. Making sure sick people have access to care would help guarantee their right to participate in society - so health care for them is a matter of civil rights, albeit not a primary right. For similar reasons, programs like affirmative action are considered necessary adjuncts to civil rights for African-Americans; to ensure a specific group has the opportunity to participate fully in society. For sick people, you could solve that problem by guaranteeing us access to care, or by reorganizing the system to provide universal care. I think we're agreed that the latter is the best option.

"7 Years" It is quite obvious that you are in medical school, and have been there for a long time, because you really have no clue what it is like out in the real world. Do you really think that you are going to "enjoy the lifestyle of the top .5% of the world" just because you have MD after your name? Get real.

That's just the start of your cluelessness. Your comment is so filled with ignorance, I don't even know where to begin. And the idea that you are going to be a doctor soon? Talk about a chilling effect ....

NurseK is quite right. Recasting health care as an "entitlement" as opposed to a "right" doesn't really change the basic issue -- namely should one person be forced to pay for another's health care.

Any person is legitimately entitled to goods or services such as food, housing or health care that he can purchase with his own money, or is contractually promised to him (via prior voluntary agreements), or is voluntarily given to him via charity.

Anything else would require government coercion - either directly imposed against the provider of health care or against someone who has to pay for that provider.

As you correctly note, individual rights are freedoms of actions (such as the right to free speech). The only proper role of government is to protect those rights and to stop people from initiating force or fraud against others.

When the government starts guaranteeing additional entitlements, it oversteps its proper functions and becomes a rights-violator not a rights-protector. And this is the fundamental problem with any sort of government-sponsored "universal health care".

Just because I am in medical school does not mean I am 21. Have some respect for different opinions. You don't know me or my life experiences. I could have a Phd in human geography, have been a mayor, or even been a nurse for 30 years.

And YES, I do assume you that physicians live better than 95.5% of the PLANET. I believe, you, are the ignorant one if you don't know how most of the people on this planet live. I DID NOT SAY TOP .5% of the U.S. did I? Have you ever traveled on a jet plane? Read anything?I would actually argue that docs are probably living in the .1% of the human bracket but I don't want to worry about exaggeration.

Sorry your arguments lack any sound reasoning. I have a progressive stance and nothing more.

What a fantastic piece - I love that you're examining the argument from an angle I haven't seen in any other place yet. I think I have to agree with you - semantically, what you're saying makes sense. Thanks for giving me something solid to think about this afternoon - I linked to it at ChronicBabe.com. Best wishes, Jenni

When someone such as myself opposes government-guaranteed health care, another person inevitably brings out the "patients will die in the streets" argument.

That's a huge non sequitur. I'm a strong advocate of private charities to help take care of patients who need care but can't afford it on their own. I regard that as a completely moral activity, when that health care is given *voluntarily*, according to the donor's values and priorities. And my wife and I donate to charities of our choice accordingly.

There's a huge difference between saying "X is good" and "X should be guaranteed by the government". Someone can legitimately support the first, but oppose the second.

For example, I fully support parents *voluntarily* donating the kidneys from their young son who just died in an MVA and I would encourage them to do so, but I would completely oppose any law which would *require* those parents to donate, even it means that some potential recipient out there will have to wait for a different donor kidney.

If someone then argued, "So you must be a heartless bastard who wants people to die of renal failure!", then they'd be completely wrong.

It's also interesting that in the so-called "compassionate" socialized systems of medical care, those governments routinely deny care to those who need it, through rationing and waiting lists. Those systems actually *do* let their patients die, but that seldom gets reported in the US.

I don't think my statement about "dying in the streets" is either non-sequitur or illegitimate, because there is currently very little charity-based care available, so your solution doesn't work. No government can legislate "charity" care; they can provide for the poor directly from taxpayers' dollars, however.

If you don't like that solution, and you know there are currently too few "charity" resources to solve the problem, what do you propose to do about people who need health care now?

There is lot of charity care provided. Thirty percent of care provided on my emergency room is charity care. Medi-cal (calfornia medicaid) pays about the lowest of the 50 states so it is not a stretch to say another 20% is charity care.

I used to work in a charity clinic. I enjoyed it much more than working for money. My insurance company then informed me that they would not cover my liability and I would be completely bare. So now because of a small minority of ungrateful US bastards and their attorneys I leave the country to provide charity care.

Judd raises an excellent point. We can advocate for tort reforms and other measures that will make it easier for those who want to give charity care to do so.

We can also adopt various free market health care reforms that reduce insurance costs and make it easier for people who want to buy insurance but can't currently afford it.

One book that this discusses this issues is from David Gratzer, a physician who has worked in both the Canada and the US:

"The Cure: How Capitalism Can Save American Health Care"

His documentation of the long waiting lists in Canada and the higher mortality rates for treatable conditions is chilling. He also provides excellent historical background on how health insurance became linked to employee benefits as a result of bad IRS policies, with all the resultant problems. His basic conclusion is that capitalism, not socialism, is the way to address the problems. He offers a number of practical, concrete proposals to fix our current problems, all of which are based on decreasing government interference in medicine.

I'm all for tort reform, believe me. Frankly, I was shocked when Judd said his malpractice carrier refused to cover him practicing charity care.

And I don't necessarily believe that government-sponsored, single-payer, universal health care is the ideal solution to our current problem, although I like that idea better than what McCain has proposed. My main concern is ensuring, somehow, that everyone has access to needed medical care. I also believe physicians should be compensated for their services. The two concepts are not mutually exclusive, unless we continue down the path we are currently on.

When are people going to realize that free market anything solves nothing. Greed takes over. You would think that with the current 700 billion dollar bailout right now, some diehards would begin to recognize this as a possible truth. We, the tax payers are currently bailing this system out!

One just has to look at the crapping economy, environmental degradation, unequal healthcare and financial distributions, and 11 trillion dollar national debt to see that free market capitalism is a failure.

I enjoy your site and usually agree with your posts, but I have to respectfully disagree this time. In the field of human rights, health is viewed as a right, and part of health (certainly not all) is access to health care. Also, human rights law frequently interchanges "rights" and "entitlements." I agree with your bottom line though that the US needs universal health care--there is no question about that.

If you believe the banks were operating in a free market, you are more naive than I thought. Like most other things you mentioned, it was your beloved government interventions that caused the problems.

7 years: When are people going to realize that free market anything solves nothing.

Tell that to the millions who died in the Soviet Union or China under communism.

*Sigh* Mental midgetry.

When I went to Germany this past year, I met a girl who'd grown up in communist Czechoslovakia.

What was it like? Oh, well, for instance, we had food, but we only had like one kind of food. There was only one flavor of yogurt--plain, for instance.

That's kind of how I view a universal health care plan. All the greatness of American health care will likely be stripped down to the equivalent of plain yogurt. Sure, plain yogurt ain't that bad, I mean, a little sugar, and it's tolerable, but it really ain't that good either and would get old and tiresome after awhile. In the case of health care, anything you want or need has the chance to be legislated away just like fruit in the yogurt to save money.

Thirdly, you got to be kidding me if you think government regulation is what causes environmental degradation. We would all be choking on smoke stacks and eating 3 eyed fish for dinner if the health of our planet was placed into the hands of free market, neoliberal profiteers.

What I find interesting are the simple thinkers out there who believe that anyone that advocates social reform, checking corporations, and spending money wisely is a communist.

BTW, do you want to compare educations? I think not.

Both of you fail to realize that I am actually willing to sacrifice more of my earnings to ensure my fellow Americans, like yourselves, are healthy and have the social services they may need. You offer me nothing. I doubt you would have these political and economic views if you were some of the unfortunate today. I am sure you would be lining up for universal healthcare if you were worse off. What makes me more genuine is that I know I would be looking for assistance and that, although I am not, I support it in health and in the limited amount of financial security I have right now.

Sometimes people stay in academia and get multiple degrees in multiple fields and multiple letters after their name because they can't survive in the real world. Just sayin'. I mean, obviously you've been in academia too long if you really think the free market has done nothing for the world.

I'm out there working my ass off in charity care central; that gives me a right, just like anyone here, to comment on this issue. So back off.

In my state, 72% of the uninsured are employed (compared to 71% of the insured--including homemakers etc) and of those people, 80% work > 30 hours per week. The vast majority of the uninsured do not get insurance because it is not important to them (most of the uninsured are ages 18-24 and healthy) or they can't afford it despite working.

McCain's plan makes insurance more affordable for the vast majority of people who would purchase it if it were affordable. There is no reason to give out welfare programs to every healthy man and woman when we haven't even allowed the free market to properly work.

Of course, I believe you have a right to whatever you want to say but don't smack me with lame insults and I will do the same.

The way I look at it, this whole private health insurance thing mostly bothers me because of three reasons.

1. There are people at top of these organizations making way too much money.

2. It is so inefficient. I watched the nurses I worked with fill out preauthorizations half the day when the docs needed them. I had to fill out different forms in different ways, with different ICD-9 codes for various insurance groups. Our BILLING STAFF was 3 times larger than the providing staff. This piece meal system sucks.

3. Insurance rarely works right when you need it. Do you really feel you are covered by your insurance? Last year I got sick while in medical school. I was in the hospital for a week. Despite having paid insurance my whole life, guess how much they covered? Maybe 30%. They find a loophole or they just flat deny you. There is little to nothing you can do short of hiring a lawyer and spending the next couple years in court to protest their greedy, self serving decisions.

Just saying- I want something better. And I don't trust any of the private insurance companies in existence to provide that.

In the free market, executives make what the free market says they should get. If you think it's "too much", try to take over their job and say you'll take less money. See how that works out. Hint: You'll lose the company an assload of money and piss everyone off. Believe it or not, the skills to run a health care organization are rare enough to command that kind of salary.

It's not evil to make a decent living. It's not evil to enter into contracts for payment from insurance companies and collect money for services rendered.

If your health care insurance denied your claim, you probably did something silly like get admitted for mental health (who pays for that anymore) or go to an out-of-network hospital at which your insurance had no contract.

My insurance has been great, but it's my responsibility to read the policy if I want to know what is or is not covered.

Oh, I should say too, that, at least in my state, no need to hire a lawyer, there is actually an agency in charge of investigating insurance companies who deny claims under the heading of the Attorney General's Office. Hopefully there are investigators who do that sort of thing in your state as well. If whatever happened to you should be clearly covered and it wasn't, contact the atty general's office and file a complaint. That usually gets people in line.

There is a fundamental difference in our philosophies. That is fine. Maybe it is even genetic. Just as some are built introverted or extroverted and others mentally stable or schizo, there may even be a biological difference that makes one a social type and another an individualist/hoarder type.

I just see things going in the wrong direction. You say there is nothing evil amount making obscene amounts of money and I frankly do in the context of overwhelming national and international poverty.

Although neoliberalism rarely takes it's market's own ecological footprint or social tolls into account, the earth does have a finite amount of energy and resources. People can also only tolerate so much inequality.

There is absolutely no reason one person born into this world should struggle to eat when others buy their 5th home; That someone gets to consume more of the earth's fossil fuels while another searches for pieces of scrap wood or endures the cold for yet another winter. Its injustice. The top 1% own 40%+ of the world's wealth. America consumes more than her fair share of the world's natural resources. Where we differ is that I care about these issues.

Believe in expanding free trade? Fine. But realize that this will only hurt us little people in the long run. Globalization favors economies of scale. What happens? The little people begin to fade out of focus: Less jobs as they exponentially grow and the existence of populations marginalized by the withdrawal of their historical resources by foreign mega-corporations. I.E. Coca-Cola in Bolivia, Mexico, and India.

Different views on life here. These are some of the views that make me more likely to support a Universal healthcare system including my distrust in corporations to do the right thing and for markets to control themselves.

It's not naivety, its a view from the other side.

I don't think you free market corporate folks are going to be happy until there is a freakin' walmart, rite aid, anthem blue cross, and mickey D's on every street corner around the world like they are here. Our cities and towns are being overrun by these mega giants and our lives are being homogenized. I will probably end up working as a doc at Pizza Hut's Hospital chain.

thanks for the info on disputing insurance btw7

For info on why free markets and conventional economic theory fail to take the environment and its frailties and finite nature into account I have always enjoyed the writing of Rees, a prof. at UBC.

Rees, W. (1990). Sustainable development and the biosphere. Teilhard Studies Number 23. American Teilhard Association for the Study of Man, or: The Ecology of Sustainable Development. The Ecologist 20(1), 18-23.

7 years: You are having a pointless conversation here. Nurse K is a troll. Let's look a some of her statements

"I'm out there working my ass off in charity care central; that gives me a right, just like anyone here, to comment on this issue. So back off."

The fact is Nurse K gets paid for her shifts. She is not giving out any charity care. Her docs who are always within a 30 second jog from her are, but she is not...period.

"Sometimes people stay in academia and get multiple degrees in multiple fields and multiple letters after their name because they can't survive in the real world. Just sayin'".

Opinions are like assholes. Everyone has one. Notice how she didn't give any evidence to back hers up? Just sayin"G".

"When I went to Germany this past year, I met a girl who'd grown up in communist Czechoslovakia.

What was it like? Oh, well, for instance, we had food, but we only had like one kind of food. There was only one flavor of yogurt--plain, for instance."

Of course this sad woman gets socialised care from the german state presently. Apparently no complaints.

"My insurance is great.

In the free market, executives make what the free market says they should get. If you think it's "too much", try to take over their job and say you'll take less money. See how that works out. Hint: You'll lose the company an assload of money and piss everyone off. Believe it or not, the skills to run a health care organization are rare enough to command that kind of salary."

Of course nurse K doesn't know Bill McGuire former CEO of United health care. His antics are all over the papers. Let's look outside healthcare at the CEO's of those genuises at the WaMu, Lehman Brothers, Freddie Mac/Fannie Mae, Bear Stearns, etc, etc. Those genuises just brought our economic system to the brink of catastrophe with unrestrictd "free market", thanks to Phil Gramm's and friends gutting of the depression era Glass-Steagall act (look it up nurse K, use the internet for once to open your mind). To be fair and apolitical Clinton signed the law. The dirty secret is that board of directors are the ones to decide CEO's salary/compensation. Who is comprised of the board? Usually crony's of the CEO. Oftentimes CEO's of other company's. Who is usually absent from these boards?Stockholders and employees. With the fox guarding the henhouse of course salaries are going through the roof. Dear nurse K, you have fallen into the trap of believing these people really are something special. They (usually) are not.

It is not a right or a moral choice, it is a matter of mutual survival. We all suffer with when a population is unhealthy and less productive, when employers cringe about the addition of another employee to insure, when insurance premiums increase wildly or or when an employee seeks a job not suited to his wishes or expertise but for benefits. Without health care for all the results are keeping us back from progressing as a society. As far as those pesky Medicaid patients with their extra challenges, how in the world do doctors become better at their profession without taking care of sick people? We are all connected in this system, we may as well all pay for it. Voila, Medicare for all.

Enjoyed your post. It seems to me that you are playing a game of semantics (aren't we all, though!?!) Here's my take on this issue: http://globalhealth.wordpress.com/2006/10/26/is-health-a-human-right/

Health Care - most folks seem to ignore, is a personal responsibility. People, let's face it, do dumb things to their health. Exercise and eating right - is not as fun to most as over eating and doing sedentary activities. We don't go to our regular physicians, and if we do we don't follow their advice.

Yet, when we get sick we feel its our "right" to demand doctors fix us at any cost, with that cost being societies burden. The ER has taken a pledge to do no harm - and they MUST save us. We spend massive amounts to extend our lives months, or weeks - after wasting years of opportunity to do the same with just a little personal effort.

The health care system is broken, but not on the end which anyone wants to talk about.

Take a walk through WalMart - or whatever your local "discount" grocery store is. That slice of America I doubt will be the picture of personal health - not due to genetics or some horrible society imposed life. But due to people generally abusing their bodies, as is their RIGHT, and reducing their health.

Its not their RIGHT to demand we fix them, extend their lives, or give them free care - when they have used a real personal right to get there.

I would like to see the reform be such that health care is a two way street, you get more care from your hospital, when you work and use your personal right to improve and maintain your health. And the only basic RIGHT (entitlement) you should be extended when you don't, is the very basic, basic measures extended for life saving, not life extending...

Its time America grew up, and realized entitlements make for lazy people - give a man a fish and he'll be back tomorrow for another... teach him to fish, its not your fault if he starves - you taught the man to fish.

Life and health are personal things, but the right is yours to choose what you do with it - not to demand a doctor repair the damage you've done, especially if you have ignored or neglected the opportunity to work on it with them.

You guys rock. I'm incredibly thrilled people are talking so heartily about health care. But I wanted to put my 2 cents in about free market, versus redistribution of wealth.

For those of us that seek to protect ourselves from inevitable doom at the hands of life's happenings (cancer, car accident, brick falling off building) we purchase insurance.

It's not really free-market insurance (because anything outside your employer's plan is unaffordable) but let's ignore that for the moment.

Within that insurance system, you pay a massive amount of money. Effectively, the reason you pay, is to cover the costs of your co-insured, anonymous friends. They may be gaming the company, they may use health care more than you, they may have cancer and require much more care than you... but you pay for them. You pay for them in higher premiums. So that is already redistribution of wealth... within today's system.

And it gets worse... the 30% of the population that don't have health care, still go to the emergency rooms. Where, rightly so, doctors are required to treat them. The doctors still need their (reasonable) salaries paid, and the hospitals need their (massive, unreasonable) cut, so in the end, these fees are added on to those who pay. Those are ... us. The insured. It is covered in higher premiums and higher deductibles.

So what's my point? You're already paying for it. But without a national policy, lots of people show up and get care... without paying. And some insurance companies are screwed when the system is gamed. And some hospitals are screwed when it has to support a higher population of the uninsured.

Regardless of whether we consider health-care a right, or a responsibility, or a privilege, we can also think of this in very practical terms. Everyone needs care, just like they need police protection and good roads. So everyone, absolutely everyone, must pay.

Nonsense - Major BS Alert - the guy in Michael Moores movie went to an emergency room, they did not sew his finger back on. Tell the guy in Michael Moores movie your nonsense about how you can just go to an emergency room.

The guy, at the emergency room , was going to be charged $70,000 for one finger and $12,000 for the other finger. Because he did not have $82,000, they only sewed the one finger back on, for which he paid $12,000, and for which he and his wife had to scrounge. This stuff about free emergency rooms is a lie. Get your story together people.

Jesus - this the dichotomy between 'redistribution of wealth' and 'earned success' is totally false and misses just about 90% of any economics class.

The Health of citizens offers two benefits. One of the benefits is to the individual. If I get sick, it is to my benefit to get treatment. Fair enough.

The second benefit is to society. When I am healthy, I can work to make my employer rich, mow my lawn, volunteer in my community, not spread communicable diseases to others and so on.

Whenever costs are treated as if there were only an individual benefit, you have serious efficiency problems. I only get one finger fixed and become that much less productive to my employer and so on. This is the main justification for government involvement and it applies to alot of things like education, military, greenspace, police, fire, and so on.

The extent of government involvement in Healthcare is something I'm going to let the US decide for itself.

The US Constitution actually is intended to 'to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity.' There is a clause that relates to reasonable limits that includes Human Rights amendments, but that's different from what a "right" is in general.

In reality, a right is an entitlement that ought to be bestowed on individuals for equality or other ethical reasons. Whether Healthcare suitably belongs on the list of entitlements is a subject of (obvious) debate.

It's so riduculous that conservatives think of themselves as religious people when in reality none of their values are godly at all. What kind of god would want someone to deprive the poor, deny certain people healthcare, discriminate against minorities, harm the environment, help the rich SOBs who already have it easy, make it difficult for those that are already unfortunate, and engage in other evil deeds like those? Sorry, but if you are a person with REAL morals, then you'll consider that healthcare is a RIGHT. Other capitalist countries have universal coverage and they are ALL thinner and healthier than we are. In this "screwed" system of ours in the U.S, we already pay for others to receive quality services while we struggle to do so on our own. Hell, I ain't no liberal either, thus I'm not a hypocrite myself. So don't repsond back to me because I'll delete your message right away and not read it at all.

Well the UN is in fact VERY clear on its position which The US SIGNED:

Article 25 of the U.N. Universal Declaration of Human Rights (1948) reads (emphasis mine):Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.Likewise, Article 12 of the U.N. International Covenant on Economic, Social, and Cultural Rights (1966) reads:1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:

(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;

(b) The improvement of all aspects of environmental and industrial hygiene;

(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;

(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

Universal Health Care IS a right. Unfortunately at the moment the medicare system along with drug companies in the US has opted to act as extortionists pure and simple. The essence of the Hippocratic Oath is: "Do no harm". By not allowing everyone access to medical care due to economic status, doctors ARE doing harm. Rememeber the addage: an ounce of prevention....!

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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